Epidemiology of surgery associated acute kidney injury (EPIS-AKI): a prospective international observational multi-center clinical study
Authors: Alexander Zarbock, Raphael Weiss, Felix Albert, Kristen Rutledge, John A. Kellum, Rinaldo Bellomo, Evgeny Grigoryev, Angel M. Candela-Toha, Z. Aslı Demir, Vincent Legros, Peter Rosenberger, Patricia Galán Menéndez, Mercedes Garcia Alvarez, Ke Peng, Maxime Léger, Wegdan Khalel, Mukadder Orhan-Sungur, Melanie Meersch, Hichem Makhloufi, Rachida Sakhraoui, Amel Ouyahia, Mounira Rais, Aya Tinhinane Kouicem, Khawla Derwish, Meriem Abdoun, Ilhem Ouahab, Souad Bouaoud, Anisse Tidjane, Carlos Jose Pérez Rivera, Juan Pablo García, Ke Peng, Fu-hai Ji, Zheng-min Ma, Peter Sklienka, Mohamed Gamal Elbahnasawy, Shady Elsalhawy, Ahmed Mahmoud Nafea, Nermin A. Osman, Moataz Maher Emara, Mohamed Mamdouh Bonna, Ibrahim Abdelmonaem Abdehaleem, Ahmed Mohamed Abbas, Mostafa Samy Abbas, Hany Mostafa Esmaeil, Oliver Joannes-Boyau, Vincent Legros, Thierry Floch, Salvatore Muccio, Lison Menage-Innocenti, Benjamin Brochet, Marion Leclercq-Rouget, Claire Geneve, Bernardita Valenzuela Mocarquer, Christophe Aveline, Pierre Vautier, Julien Nadaud, Thomas Rimmelé, Valérie Cerro, Stéphanie Suria, Jamie Elmawieh, Rita El-Jawiche, Cédric Cirenei, Gilles Lebuffe, Sébastien Ponsonnard, Pierre-Yves Egreteau, Carole Ichai, Vanessa Jean-Michel, Maxime Léger, Sigismond Lasocki, Charline Masson, Emmanuel Rineau, Viviane Cassisa, Pierre Verrier, Enora Atchade, Charles-Edouard Rochon, Vidal Quentin, Nina Queixalos, Thierry Braun, Hubert Grand, Nicolas Mayeur, Marie Pasquie, Pierre Garçon, Vincent Bruckert, Gaël Pradel, Andersen Ramorasata, Céline Ravry, Nicolas Mottard, Alexander Zarbock, Melanie Meersch, Raphael Weiss, Thilo von Groote, Christian Dörr, Mira Küllmar, Christina Massoth, Arash Motekallemi, Khaschayar Saadat-Gilani, Felix Albert, Laura Kerschke, Michael Storck, Julian Varghese, Carola Wempe, Linda Grüßer, Ana Kowark, Timo Brandenburger, Andreas Hohn, Peter Rosenberger, Helene Häberle, Pascal Hofmann, Jonathan Kuhle, Stefanie Calov, Alice Marie Bernard, Valbona Mirakaj, Kathrin Weber, Kathrin Pfister, Lena Stetz, Sarah Dorothea Müller, Stephan Klaus, Marco Sadlo, Carina-Kristin Stenger, Ulrich Göbel, Matthias Heringlake, Eleni Arnaoutoglou, Panagiota Stratigopoulou, Pantazi Danai, Antonia Dimakopoulou, Apostolos-Alkiviadis Menis, Orestis Ioannidis, Humam Jalaawiy, Aeshah Anwar, Hashim Talib Hashim, Hogir Imad Rasheed Aldawoody, Andrea Cortegiani, Mariachiara Ippolito, Claudia Marino, Gabriele Presti, Dario Calogero Fricano, Silvia De Rosa, Andrea Bianchin, Gianluca Paternoster, Umberto Fasciano, Salvatore Lucio Cutuli, Savino Spadaro, Enrico Bussolati, Marco Palmieri, Carlo Alberto Volta, Vincenzo Francesco Tripodi, Diego Fiume, Angela Iuorio, Clemente Santorsola, Bilal Abu-Hussein, Khaled Hasanein, Seokyung Shin, Jongyoon Baek, Sehui Kim, Muhammed Elhadi, Wafa Aldressi, Issa A. Abuzeid, Mohammed N. Albaraesi, Mohamed Aziz Moftah, Sarah Aldressi, Wegdan Khalel, Eman Abdulwahed, Entisar Ahmed Ali Alshareea, Akram Abdulhamid Ashur Abujrad, Reem Ghmagh, Marwa Isa Biala, Khawla Derwish, Rayet Al Islam Benjouira, Mohamed Aliwa, Ahmed Msherghi, Ahmed Tuwaib, Tahani Mustafa, Haifa Zriba, Hamza Mahmoud Agilla, Bahaeddin Taher Sadek Ben Hamida, Rema Hassan Mohamed Otman, Maja Mojsova Mijovska, Anne Marie Camilleri Podesta, Gilberto Adrián Gasca López, Sarah Amro, Rita de Freitas Regufe, Evgeny Grigoryev, Artem Ivkin, Dmitriy Balakhnin, Dmitriy Shukevich, Michael Yaroustovsky, Abdulnaser Barmou, Alexander Kaserer, Clara Castellucci, Samira Akbas, Andreja Möller Petrun, Irena Gregorcic, Vesna Sok, Andre Links, Elizabeth Bárcena Barreto, Javier Ripollés Melchor, Ángel Becerra-Bolaños, Aurelio Rodríguez-Pérez, Javier Mata Estévez, Juan Mulet Matas, Sara Pérez Palao, Mercedes García Álvarez, Albert Bainac Albadalejo, Astrid Batalla González, Ana María Gómez Caro, Ignacio Hinojal Blanco, Diego Toral Fernandez, Gracia Herranz Perez, Margarita Logroño Ejea, Noelia de la Rosa Ruiz, María Gastaca Abasolo, Lourdes Ferreira, Félix Lobato, Marta Aguado Sevilla, Andres Erazo, Berta Castellano Paulis, Isabel de la Calle Gil, Peter Adamove, Francho Miguel Blasco Blasco, Jose Ignacio García-Sánchez, Sara García Zamorano, Natalia Gijón Herreros, Raquel Callejas, Mercedes Estaire Gómez, Angel M. Candela-Toha, Elisabeth Claros-Llamas, Pilar Cobeta-Orduña, Pascual Crespo-Aliseda, Trinidad Dorado-Díaz, María Gómez-Rojo, M. Nuria Mané-Ruiz, M. Carmen Martín-González, Adolfo Martínez-Pérez, Carlos Tiscar, Patricia Galán Menéndez, Verónica Estepa Calvo, Laura Llinares Espí, Yuri Santiago Loaiza Aldeán, Víctor Morales Ariza, Laura Villarino Vila, Francisco Javier García-Miguel, Elfayadh S. M. Suliman, Ahmed Mohamed Ibrahim, Hammad Ali Fadlalmola, Sarya Swed, Vin-Cent Wu, Mukadder Orhan-Sungur, Demet Altun, Nur Canbolat, Müşerref Beril Dinçer, Serap Aktas Yildirim, Muzeyyen Iyigun, Davud Yapıcı, Levent Özdemir, Aslınur Sagün, Neval Boztug, Emel Gündüz, Demet Lafli-Tunay, Deniz Karakaya, Burhan Dost, Ozgur Komurcu, Ozlem Korkmaz Dilmen, Eren Fatma Akcil, Yusuf Tunali, Gulay Ok, Eda Tok-Alsina, Cengiz Polat, Nurcan Kızılcık, Öznur Şen, Kamil Darçın, Semra Uğur, Yavuz Gürkan, Kemal Tolga Saracoglu, Özge Yıldız-Koyuncu, Z. Aslı Demir, N. Aysun Postacı, Ayşegül Özgök, Ümit Karadeniz, Hülya Yiğit Özay, Eda Balcı, Nevriye Salman, Behiç Girgin, Ozlem Sagir, Hafize Fisun Demir, Fatih Ugun, Hüseyin İlksen Toprak, Mustafa Soner Özcan, Filiz Alkaya-Solmaz, Mehmet Yilmaz, Umran Karaca, Sevtap Hekimoglu Şahin, Süheyla Karadağ Erkoç, Neslihan Alkış, Volkan Baytaş, Engin Erturk, Sedat Saylan, Ali Akdogan, Beyza Büyükgebiz Yeşil, Omer Faruk Boran, Yavuz Orak, Feyza Çalişir, Sibel Büyükçoban, Bahar Kuvaki, Seda Cansabuncu, Selcan Akesen, Suna Gören, Tugce Yeniocak, Osman Orman, Özlem Ersoy Karka, Tulay Sahin, Natalia Momot, Anna Panchenko, Jean-Francois Pittet, Kristen Rutledge, Ahmed Albishti, Mohamed Alsori, Salmi Hamza Abrayik
Journal: Intensive Care Medicine (2023)

The incidence, patient features, risk factors and outcomes of surgery-associated postoperative acute kidney injury (PO-AKI) across different countries and health care systems is unclear. We conducted an international prospective, observational, multi-center study in 30 countries in patients undergoing major surgery (> 2-h duration and postoperative intensive care unit (ICU) or high dependency unit admission). The primary endpoint was the occurrence of PO-AKI within 72 h of surgery defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Secondary endpoints included PO-AKI severity and duration, use of renal replacement therapy (RRT), mortality, and ICU and hospital length of stay. We studied 10,568 patients and 1945 (18.4%) developed PO-AKI (1236 (63.5%) KDIGO stage 1500 (25.7%) KDIGO stage 2209 (10.7%) KDIGO stage 3). In 33.8% PO-AKI was persistent, and 170/1945 (8.7%) of patients with PO-AKI received RRT in the ICU. Patients with PO-AKI had greater ICU (6.3% vs. 0.7%) and hospital (8.6% vs. 1.4%) mortality, and longer ICU (median 2 (Q1-Q3, 1–3) days vs. 3 (Q1-Q3, 1–6) days) and hospital length of stay (median 14 (Q1-Q3, 9–24) days vs. 10 (Q1-Q3, 7–17) days). Risk factors for PO-AKI included older age, comorbidities (hypertension, diabetes, chronic kidney disease), type, duration and urgency of surgery as well as intraoperative vasopressors, and aminoglycosides administration. In a comprehensive multinational study, approximately one in five patients develop PO-AKI after major surgery. Increasing severity of PO-AKI is associated with a progressive increase in adverse outcomes. Our findings indicate that PO-AKI represents a significant burden for health care worldwide.